RACP Divisional Written Exam · FRACP

Clinical Epidemiology for the written exam

Everything Physify has for Clinical Epidemiology: short lessons written to Australian guidance, exam-style questions with a worked explanation for each, and Bedside, our AI tutor, under every one. Try a question below, no sign-up.

courses
6courses
lessons
38lessons
exam-style questions
194exam-style questions
figures in the lessons
4figures in the lessons

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Clinical Epidemiology

A 58 year old woman has CT for renal colic, which shows a 2.4 cm homogeneous left adrenal mass with an unenhanced attenuation of 4 Hounsfield units. Blood pressure is 128/78 mmHg, potassium 4.2 mmol/L, and she has no features of Cushing syndrome. What is the most appropriate next step?

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What's covered

6 courses, each a set of lessons with a quiz after them. The bar shows how many questions each has. Open a course to see its lesson outline.

From the lessons

4 figures sit in the Clinical Epidemiology lessons: ECGs, diagrams, films and clinical images, each with what to look for. Here are 2. Tap one to enlarge it.

An illustrative forest plot of six trials with a harmful outcome such as death, risk ratios on a log scale from 0.25 to 2. Each trial is a blue square at its point estimate, with area proportional to its inverse-variance weight, on a horizontal line showing its 95 per cent confidence interval; trial D, the largest, carries 37 per cent of the weight and trial C, the smallest, 6 per cent with the widest interval. Every trial's interval crosses the vertical line of no effect at 1. The pooled fixed-effect estimate is a red diamond at 0.79, its width the pooled interval of 0.68 to 0.93, which is clear of 1, so pooling gives a significant result although no single trial was. Ratios below 1 favour treatment and above 1 favour control. Heterogeneity is Q 1.93 on 5 degrees of freedom, p 0.86, with I squared 0 per cent, so fixed-effect and random-effects models agree. A key explains I squared as (Q minus df) / Q, about 25 per cent low, 50 moderate and 75 high, and that the null is 1 for ratios and 0 for differences.
Physify teaching diagram. Tap the image to zoom.

From the lesson “Meta-Analysis, Heterogeneity and Publication Bias” in Biostatistics & Evidence-Based Medicine

A 2 x 2 table with the reference standard in the columns (disease present, disease absent) and the index test in the rows (positive, negative): a true positives, b false positives, c false negatives, d true negatives. Sensitivity a / (a + c) and specificity d / (b + d) are read down the columns; positive predictive value a / (a + b) and negative predictive value d / (c + d) across the rows. LR+ is sensitivity / (1 - specificity) and LR- is (1 - sensitivity) / specificity. Below, an ROC curve plots sensitivity against 1 - specificity: the diagonal is a test with no discrimination and an area under the curve of 0.5, a good test bows towards the top left corner with an area of 0.85, and three cut-offs show that lowering the threshold moves the point up and to the right, raising sensitivity and lowering specificity. The slope of a line from the origin to a point is the LR+ at that cut-off.
Physify teaching diagram. Tap the image to zoom.

From the lesson “Continuous Results, Thresholds, Decisions and Agreement” in Diagnostic Tests and Probabilistic Reasoning

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